Provider Demographics
NPI:1124178975
Name:PATEL, MAHENDRAKUMAR A (MD)
Entity Type:Individual
Prefix:DR
First Name:MAHENDRAKUMAR
Middle Name:A
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 8TH AVE W
Mailing Address - Street 2:STE 101
Mailing Address - City:PALMETTO
Mailing Address - State:FL
Mailing Address - Zip Code:34221-4737
Mailing Address - Country:US
Mailing Address - Phone:941-776-4008
Mailing Address - Fax:941-845-4963
Practice Address - Street 1:888 N ROBERT AVE
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:FL
Practice Address - Zip Code:34266-9580
Practice Address - Country:US
Practice Address - Phone:863-494-8401
Practice Address - Fax:863-491-5306
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2017-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 47370207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL51269OtherBC & BS
FL042518400Medicaid
FLD85924Medicare UPIN
FL042518400Medicaid